Danger vs Safety: When Pain Persists...
Chronic pain states that defy tissue healing timelines impact 25% of Australians, New Zealanders, Canadians and Americans, and the cost is huge – in 2007, it cost Australians $33 billion.
Pain research has come a long way and with it the definition of pain has changed. A current definition from Lorimer Moseley and David Butler states that pain is ‘a perceptual interference, whereby the experience is considered an output into consciousness that reflects the best guess estimate of what will be an advantageous response (the tendency will usually be to err on the site of protection).’
What does this mean, exactly?
You will have pain when your brain concludes that there is more credible evidence of danger related to your body than there is credible evidence of safety related to your body. Basically, everything your brain perceives as evidence of danger or safety can potentially influence your pain.
When you’re hungry, it’s not because your stomach tells your brain its hungry, it is because your brain prompts you to eat. Thirst is the same, and pain is no different. Your body doesn’t send pain messages to your brain, it sends danger signals.
Your nervous system is working for you, to look out for you and help you when needed. Pain exists to protect you – consider it a gift! Your pain experience is strongly influenced by context - your location, situation and current setting, your beliefs and values, the understanding and knowledge you possess. Your context provides unique meaning to your experiences.
These are the seven key categories in which your brain can perceive safety or danger:
Things you smell, touch, taste and feel – your sensory experiences. Hearing a diagnosis that sounds bad without really knowing what it means vs getting a gentle massage.
Things you believe. Believing in your doctor or Physio vs pain is forever.
Things you say – voicing your beliefs. “Its old age” vs “I can see the light at the end of the tunnel.”
Things you do – your actions. Making an appointment to see a health professional vs staying home, in bed, watching Netflix.
Places you go. Going to the place where you first injured your body vs having a local anaesthetic that blocks danger messages being sent to your spinal cord and brain.
People you meet – those you surround yourself with. A Doctor or Physio who is up to date on the latest pain research vs an out of date Doctor or Physio.
Biological state – your bodily state. Feeling depressed or anxious vs feeling happy and optimistic. Acute inflammation.
The important thing to realize is that these are all modifiable based on your experience and your learning. What is perceived as safety to one may be danger to another. Someone who had a massage that leads to back pain may be more likely to be frightened at the thought of going for another massage. Having an educated health professional explain your scans in language you understand and reassures you that you will get better will instil safety vs the professional who scares you into thinking you’re about to become disabled and sends you off the surgeon with no follow-up.
Remember, pain does NOT exist when your perceived safety is greater than your perceived danger. Things your brain perceives as danger can be modified to become safety – talk to us about how you can do this!